Abstract
This study aims to estimate the prevalence and burden of alcohol disorders on Emergency Department (ED) and hospital inpatients in England through the exploratory analysis of NHS data. ED attendances and admission data were linked using hospital episode statistics. Diagnoses were preserved at a patient level to identify individuals who had an alcohol attributable diagnosis. Four groups were identified; a) individuals with no alcohol disorder (NAD), b) acute alcohol disorder (AAD), c) chronic alcohol disorder (CAD) and d) those with any alcohol disorder (AD) (b) and c) combined). Associations between ED diagnosis and alcohol disorders were examined using logistic regression adjusted for hospital provider, age and sex. Non-parametric tests were employed examining ED and hospital service use. Cost differences by group was explored using a propensity scored match sample. Of the 1.2million subjects 6.7% were identified as having one or more AD accounting for 11.7% of ED attendances, 9.2% of hospital admissions and 7.2% total bed days. Bootstrapped derived means identified that hospital service use varied significantly between AAD and CAD. Whilst AAD accounted for greater attendances than NAD (2.78; 95% CI 2.680-2.879) those with CAD accounted for even greater attendances (4.33; 95% CI. 4.136-4.515), admissions (2.56; 95% CI. 2.502-2.625) and total bed days (15.14; 95% CI. 14.716-15.559). AD place a disproportionate impact on hospital services with CAD exerting the greatest burden on hospital utilization. The complexity and burden of CAD suggests this group should be a priority for intervention.
Highlights
The burden of alcohol-related emergency department (ED) attendances and hospital admissions is a priority for health services worldwide
The final data set of 1,209,760 patients were drawn from all regions of England of which 81,258 (6.7%) were identified as experiencing attributable disorders (AD) during one or more emergency hospital admission in 2009/10
Patients with chronic alcohol disorder (CAD) made up 65.8% of those with an alcohol disorder and were found to be significantly older than those with acute alcohol disorder (AAD) and were more likely to be male and Caucasian. [Consider table 2 here] ED diagnosis associated with AD For each of the 39 ED diagnostic categories the prevalence of AD revealed that seventeen clinical presentations and two unascertained categories (i.e. Nothing abnormal detected and Diagnosis not classifiable) were positively associated with AD
Summary
The burden of alcohol-related emergency department (ED) attendances and hospital admissions is a priority for health services worldwide. 5.9% of deaths and 5.1% of the burden of disease is attributable to alcohol placing increasing demands on healthcare (World Health Organisation, 2014). Analysis of nationally representative US data has identified between 2001 and 2011 alcohol-related ED attendances have increased at a greater rate than overall ED attendances placing a greater burden on hospital resources (Mullins et al, 2017). Whilst the advent of a new ED coding system in the NHS, the Emergency Care Data Set (ECDS) (NHS Digital, 2017a), may improve the identification of alcohol-related ED attendances previous attempts to link reasons for ED attendance to the presence of alcohol misuse (Huntley et al, 2001), has lacked robust analysis into the associations between reasons for attendance and alcohol disorders
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